title: [A case of culture-negative brain abscess caused by Streptococcus intermedius infection diagnosed by broad-range PCR of 16S ribosomal RNA].
abstract: A 50-year-old man presented with altered mental status during hospitalization for pneumonia. MRI showed multifocal ring-enhanced lesions, which consisted of multiple cerebral abscesses. We started empirical antibiotic therapy, but the following morning, his condition rapidly deteriorated and a CT scan revealed acute hydrocephalus, which required ventricular drainage. Gram staining of cerebro-spinal fluid from the ventricular drainage showed gram-positive cocci in chains, but culture results were negative. 16S ribosomal RNA sequencing with broad-range PCR of the cerebro-spinal fluid identified Streptococcus intermedius. On the basis of this identification, the antibiotic regimen was changed to ampicillin monotherapy. After 1 year of antibiotic therapy, all the abscesses had disappeared and the patient was discharged without any sequelae. Bacterial 16S rRNA gene analysis with broad-range PCR is a very useful method for facilitating the etiological diagnosis and selection of appropriate treatment for culture-negative infections.
authors.affiliation: Department of Neurology, Osaka Neurological Institute.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ohara
authors.forename: Katsunori
authors.initials: K
authors.lastname: Asai
authors.forename: Kiyofumi
authors.initials: K
authors.lastname: Ohkusu
authors.forename: Akatsuki
authors.initials: A
authors.lastname: Wakayama
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D012336:RNA, Ribosomal, 16S / Q000235:genetics*; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D034367:Streptococcus intermedius / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D012336:RNA, Ribosomal, 16S